19 July 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
This was a targeted inspection to check on a concern we had about people’s safety and staffing levels.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out by 2 inspectors.
Service and service type
Nightingale Court is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Nightingale Court is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make
During the inspection
We spoke with 2 people who used the service. We spoke with 12 staff including the care co-ordinator, senior care staff, care staff, maintenance staff, the kitchen staff, the domestic staff, the deputy manager, and the registered manager. We also spoke with the nominated individual on the phone. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed aspects of people's care records. We also reviewed a range of records held by the service including, incident and accident reviews, and staff supervision templates.
19 July 2023
About the service
Nightingale Court is a residential care home providing personal care to up to 43 people. The service provides support to older people who may have dementia. At the time of our inspection there were 30 people using the service. Nightingale Court accommodates 43 people in one adapted building across three floors.
People’s experience of using this service and what we found
Recruitment of new staff was not consistently robust. The provider took action to address these shortfalls and put systems in place to strengthen the recruitment process.
People told us they felt safe and were supported by staff. Staff recognised different types of abuse and how to report it. The provider understood their safeguarding responsibilities and how to protect people from abuse and had mitigated risk of harm and reported incidents to the local authority. However, notifications to the CQC had not been sent at the time as there were gaps in the managers knowledge of when these should be sent. These notifications were completed retrospectively.
Potential risks to people's health and wellbeing had been identified and were managed safely. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risk associated with people’s care. There were sufficient numbers of staff on duty to keep people safe and meet their needs. People's medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.
People's care needs had been assessed and reviews took place with the person and, where appropriate, their relative. Staff had the training and support to be able to care for people in line with best practice. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.
The manager was visible within the home and listened to people and staff's views about the way the service was run. The provider had put checks into place to monitor the quality of the service provision.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update The last rating for this service was requires improvement (published 30 July 2022).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of these regulations, however at this inspection we found the provider was in breach of Regulation 19, fit and proper person’s employed.
Why we inspected
We carried out an unannounced comprehensive inspection of this service in July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nightingale Court on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified a breach in relation to recruitment of new staff at this inspection.
Please see the action we have told the provider to take at the end of this report.
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.